What are your thoughts on privatising the NHS? Good or bad?

[Supernova23]

I would also love some input from those who have lived in countries that have private healthcare systems. Is it better or worse in your country?

For context, I love the prinicple of the NHS. I’m an NHS nurse. I also like a massive chunk of NHS nurses and doctors, think of looking for a way out on a daily basis. The lure of going abroad tempts me daily.

But as we know, we live on a tiny over populated island. People are living longer and getting sicker. People also abuse the system on a daily basis. I’ve been kicked, hit, spat at, called every name under the sun. I’ve been threatened numerous times. Me and my colleagues have been threatened by a maniac with a machete.

We are haemorrhaging staff on a daily basis. People either leave or go off long term sick. I can’t blame them.

Patients are becoming more medically complex with multiple co morbidities. In the nicest possible way, advances in medicine has meant that people who would have kicked the bucket long ago, are now people kept alive due to modern medicine. People are also getting much, much larger; this makes them more complex to manage in every sense. Even with basic bog standard care. We frequently have patients so large it takes at least 4 people reposition them. You try finding 4 spare hands on the wards; it’s a nightmare.

In my hospital alone, every single ward has multiple complex long stay patients that have been on the wards for 6+ months. In some cases it’s a year or more. The cost of these stays often runs into the hundreds of thousands, perhaps even millions, and is obviously reducing the number of patients we can admit.

I could ramble on. The system has been at breaking point for years. Would privatising the NHS improve it? Or is that cloud cuckoo land?

@taxguru I work in Crit care and my colleagues and I have saved literally 100s of lives with many grateful patients and relatives. Repeat that in every ICU.

I’m a member of a Facebook group for people with colostomies. A lot of people on it are American and they often post desperate for supplies. They are having to buy bags from Amazon from their own money because their insurance companies say they are only allowed a certain number a month, or asking where there are charities that might have bags and cleansing equipment to give.

So, not all American ostomy patients...

I agree with you that there are problems with private insurance / the US model. But scare stories are easily put in context and tend to ultimately distract from the core message.

Fwiw, I suspect the UK is headed toward a US model. The neo-liberals of the Tory party have a very unfortunate inability to look anywhere other than Wall Street/ the prosperity gospel/ the Puritans for inspiration, and I suspect many stand to gain financially from the slicing and dicing that will likely happen to the NHS.

@FrenchMustard ok surprise us. What’s your overhaul ? Most overused word on MN re NHS. Let’s guess. Cut ever wasteful management 😂when most management is clinical.

So, not all American ostomy patients...

Even one is far too many, and it’s the majority of the US people in the group. The UK members are never in that position.

If you aren’t in a position where you are at risk of sepsis because your insurance company says they won’t cover more than a certain number of bags a month and you can’t keep yourself clean you really can’t appreciate how wonderful our system is.

I’m happy to pay my NI and my income tax because without it I’d be dead. That’s the bottom line, and any system that doesn’t cover pre-existing conditions isn’t going to work for disabled people.

OK. I’m not really happy with any, but whatever.

The US system costs twice as much too. Imagine what that amount of money could do if it wasn’t funding insurance companies’ shareholders.

To permit such a system to take over the UK (and I know there are other systems, but the US one is the one we’re sleepwalking into with no legislation required) would be scandalously negligent of the government.

Privatisation needs to be fought against. We don't want a heartless system like America where it's all about chasing profit and insurers try to screw you over. We don't know how lucky we have it here.

Hear hear

I fully support privatisation, so long as our NI Contributions stop.
Nhs is broken, takes ages to get an appointment, a and e waiting times are a joke.

I'd gladly pay insurance and scrap these awful waiting lists.

"If you aren’t in a position where you are at risk of sepsis because your insurance company says they won’t cover more than a certain number of bags a month and you can’t keep yourself clean you really can’t appreciate how wonderful our system is."

Fucks sake! Yes it's beyond awful that some people in the US can't even get their colostomy bags paid for. But plenty of UK citizens probably die before they get to the colostomy bag stage because they get fobbed off. The NHS is generally fairly good once you have a diagnosis (as long as you're lucky and it didn't come too late for you) but good luck getting that diagnosis in the first place.

Honestly I know PLENTY of people who either suffered for years or even sadly died because they couldn't get seen / didn't get taken seriously / their symptoms weren't looked at as a whole and were treated one at a time so the big picture was missed. I don't think that really happens in the US anywhere near as much as here.
It's terrible that families are bankrupt because of medical bills, but however awful being bankrupt is it's still better than dead.
And anyway the US system is the one we'll end up with if people (like you!) are so bloody resistant to the change that we need.
If you are genuinely too poor to pay for insurance (or you're under 18) then the state should be covering it for you. If you're not, then you need - and me - to pay a contribution, or we're all fucked.

I just don't think privatisation would lead to an improvement in care in a system driven by profit. I think it's extremely naïve to think it would. Why is privatisation the only answer to the failures in the current system? I would argue the answer is, as I was saying earlier, more funding for the NHS, better wages, more hospitals, better living standards by building more affordable housing, state-subsidised childcare and last but not least, re-joining the EU for a larger recruitment pool and improved trade deals, hopefully resulting in a reduced cost of living.

And taking measures to reduce inequality would doubtlessly lead to better health outcomes for most people and less burden on the health service. Less crime etc etc.

It seems unlikely that the Tories will win the next election, hence Wes Streeting is likely to continue his role in Health. He's been looking at how health care is funded in multiple countries for the last couple of years. He is also on record as saying the NHS will have to change to cope with the demographics of ageing and medical progress.

IMO, only Labour has a real shot at reforming it, but if there were a genuine cross-party approach to health and social care, it would be the best thing they could achieve for us all. But I doubt the US will be the blueprint. There has to be a role for profit within any framework, because that's where innovation arises, but (I hope) it will be within a mutual model that doesn't allow insurers to exclude pre-existing conditions or to cherry pick customers by age or genetics or wealth or any other criteria. The European models don't, but they do give the patient a real choice of where and how treatment is delivered. The NHS is so beloved in the UK and so huge, that what is possible and desirable must be robustly debated to seek an agreement to put health and social care outside party politics for at least 20 years, ideally forever.

Why not just increase taxes? And make a serious attempt to bring the NHS up to standard instead of constantly making cuts that destroy any remaining shreds of efficiency.

It’s a shitshow because all of the effort has been about reducing spend without trying to improve efficiency. It’s a government failing.

Where does this money come from though? Would need you to be paying a lot more than £300 per month in additional contributions to make all of that happen.

personally I think no amount of extra money would fix the nhs, though.

Tell me you have no idea about healthcare without telling me you have no idea about healthcare. The very last thing that the NHS needs is more hospitals - in fact we actually need less. Care needs to be more centralised and naturally this is also the most cost effective way to do things too.

Well that’s just one detail in a whole list of points that meimei offered – think it was possible to add this insight without being so dismissive

On whom would the additional tax burden fall @SnakesAndArrows ? Most people calling for this generally mean "anyone who earns more than me".

Those on high earnings subject to PAYE/NIC are already paying taxes that are very close to European rates. They are also the people paying for insurance (or using that provided by their employers, which is taxed as a benefit in kind) to get access to treatment that doesn't involve endless waiting lists or massive inconvenience to access care. The problem I foresee is that employers will have to pay larger social contributions, which is likely to be fiercely resisted, and that companies will think long and hard about hiring more staff.

And the rejoin the EU comment! Ha! That's not happening! You honestly think any government is going to touch that with a bargepole? Or even that the EU would have us back?

I agree with @meimei80 ‘s post.

You picked the wrong “fact” to illustrate your supposed superior knowledge of healthcare because we do actually need more hospitals- measured by the number of hospital beds per capita. The U.K. has the 6th lowest number of hospital beds per 1,000 people (per capita) in the OECD, despite an ageing population with higher than average poor health due to poverty, deprivation, and poor primary care.

To have tertiary healthcare equivalent to that in France, we would need to double the number of hospital beds, which means ofc building more hospitals.

And this. Some absolutely ridiculous and ill informed statements in that comment

The “insight” was blindness. Hence the need for a lofty superior tone when delivering it.

@Cherryon hospital beds is not the same thing as more hospitals. Missing the point of @goldenretrievermum5 entirely….

I would happily pay more NI to go directly to the NHS

(Guess all that £350million per week going to the EU was redirected straight back to the forest of magic bullshit trees)

If we don’t pay more in tax then we’ll have to buy insurance, or hope that our employers will insure is as a perk. Which would inevitably mean lay offs or pay cuts, or both.

So whatever happens people (and I absolutely do mean me) are going to have to pay more.

My view is that the quality of healthcare should not depend on your ability to pay, therefore an income related model is most equitable.

Riiiight. So if you needed to double the number of hospital beds, how do you do this without building more hospitals?

Put two patients in each hospital bed? Have hospital bunk beds?

@goldenretrievermum5’s point was we need a more centralised system - I agree that the abundance of small hospitals is a contributing factor in current inefficiency. How we fix that inefficiency is a great question, but we do not need more total hospitals.

i’m not convinced we need more beds per capita either - if we had better throughput (move people through treatment and out of the hospital more quickly) we would be fine at current levels, which aren’t so different from Scandinavian countries or even the US.

I once stayed in hospital for 2 weeks because it took soo long to get time with a doctor, arrange diagnostics, etc. It took a further 6 months to book in all of the other diagnostics that they were unable to arrange while in hospital. in the US or in a UK private hospital that would have been done in a day.